Common drugs used in the Emergency Room Essay

By Henry Feldman, ?2001
(Edited by Lewis Nelson, MD)
Routes of administration
Intravenous administration is when the drug is given in liquid form directly into a vein. This is often
done by placing a venous catheter to allow easy administration.

Direct injection into the muscle. Often a painful mode of administration, and provides a slow route
of absorption.

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By mouth (Per Orum). Typically intermediate between IM and IV in speed of absorption. (is this
Rectal administration (Per Rectum). The rectum is actually a very quick method of drug
administration as the rectum is highly vascular. This route is often used in children.

Certain drugs can be given down an endotracheal tube. The drugs are given at 2-2.5 times normal
IV dose. Drugs are followed with a saline bolus of ~10ml. The acronym for drugs that can go down
an ET tube is ALONE:
? A ? Atropine
? L ? Lidocaine
? O ? Oxygen
? N ? Naloxone (Narcan)
? E ? Epinephrine
Drug List
Lidocaine has 2 uses: It is a local anesthetic when injected subcutaneously (and it can be used
for a nerve block). It is also an antidysrhythmic drug when injected IV (used to treat cardiac
dysrhythmias). Anesthetic preparations come in 2 forms: with and without epinephrine. The
epinephrine is added to reduce absorption and prolong the effect. A classic question by the
resident/attending is: What is the toxic dose when used as a local anesthetic (Answer: 5mg/kg for
lidocaine without epi, and 7mg/kg with epi.)
Epinephrine is a natural substance produced by the adrenal gland (a.k.a. adrenaline).

Epinephrine is used in emergencies to stimulate the heart or to dilate the bronchial tree. Its use is
limited by cardiac side effects. It is also mixed with lidocaine to prolong lidocaine?s effect and to
control bleeding.

Furosemide (Lasix)
Lasix is a diuretic, which is given IV or PO, which causes the patient to produce more urine. This
is often given to reduce the fluid overload in patients with congestive heart failure (a.k.a. CHF) or

Diazepam (Valium)
Diazepam is a benzodiazepine that is used both as a powerful sedative and as an anticonvulsant
for patients with seizures. You will see it used for alcohol withdrawal, cocaine toxicity,
and status epilepticus (i.e. uncontrolled seizures). Diazepam may produce respiratory depression.

Midazolam (Versed)
Versed is a very powerful short acting benzodiazepine type of sedative and is used to sedate
patients for painful procedures. Excessive dosing may produce respiration depression (when
given i.v.) or coma.

Haloperidol (Haldol)
Haldol is a antipsychotic with powerful sedative properties. It is often used for patients who are
acting in a psychotic manner. It should not be used to treat alcohol withdrawal or cocaince toxicity.

In sufficient quantities it will render the patient unconscious.

Often called ?sux? (pronounced sucks), it is a paralytic, resulting in total muscular paralysis. It will
most often be used for ?rapid-sequence-intubation? to make tracheal intubation easier and to
allow the patient to be mechanically ventilated. It has no analgesic properities and paralyzed
patients see, hear and feel everything – like a zombie! – thus it is never used without sedation.

Atropine is used for several purposes, including inducing the heart to beat faster (i.e.

chronotropy) as well as an antidote for certain organophosphate poisonings. It is sometimes
used as a drug for patients with severe asthma. It can also be dripped into the eyes to produce
dilation of the pupil (although this is a different formulation). Can also be used to dry up respiratory
secretions during procedures.

Heparin is an anticoagulant used to prevent blood from clotting. It is used in patients suspected
of having a myocardial infarction and to prep the syringe for an arterial-blood-gas for the same

Valproic Acid
Valproic Acid is used as an anticonvulsant medication. It is not typically used in the emergency
treatment of seizures, but toxicity can often be seen with seizure patients who have taken too

Phenobarbital is a barbiturate which is used either as a sedative and/or anticonvulsant

Similar to phenobarbital but much faster acting and with a duration of effect. It is used as an
anticonvulsant medication and to treat severe alcohol withdrawal. Often used in a continuous
drip for patients who continue to seize.

Methylprednisolone (Solumedrol)
Solu-medrol is a long acting corticosteroid. It is often used to prevent the recurrence of
anaphylaxis after the epinephrine has worn off and for patients with asthma. It has a half-life of
around 6 hours.

Albuterol (Proventil)
Albuterol is a bronchodilator, used in a nebulizer for asthma patients. Typically a drop (0.5 mg)
of albuterol is suspended in saline and nebulized with oxygen. Often referred to as ?how many
nebs the patient got?.

Ampicillin/Sulbactam (Unasyn)
This is an antibiotic (ampicillin) with the second compound added to prevent bacterial ?lactamases
from working (which interfere with penicillins). This overcomes the antibiotic resistance
acquired by many bacteria.

This is a fluorescent dye used to stain the cornea to look for scratches or ulcers. Scratches and
ulcers will selectively retain the dye, making them glow under the cobalt-blue light of an

Ketorolac (Toradol)
Ketorolac is a powerful NSAID, used for severe headaches, musculo-skeletal pain, kidney
stones and inflammation.

Morphine Sulfate
Morphine is a powerful opiate (derived from opium and similar to heroin) that is used as a pain killer
(i.e. analgesic). However, as a side effect it can suppress respirations.

Naloxone (Narcan)
Narcan is the antidote to opioids such as heroin or morphine. It is very rapidly acting and
competes with the opioid for the opioid receptor. Be careful when administering this drug, as it
may cause withdrawal in opioid tolerant patients.

Prednisone is a corticosteroid that is given for asthma and as an anti-inflammatory. A side effect
of prolonged use is Cushing?s syndrome and often you may see tremors.

Often called ?rock?, it is a paralytic. Administration produces total muscular paralysis. It is most
often used for ?rapid-sequence-intubation? to make tracheal intubation easier and to allow the
patient to be mechanically ventilated. It has no analgesic properities and paralyzed patients see,
hear and feel everything and should never used without sedation.

Pilocarpine is dripped into the eyes to produce constriction of the pupil in patients with glaucoma.

Dopamine is a mild pressor agent, which is administered IV to produce vasoconstriction and raise a
patient?s blood presure.

Phenytoin (Dilantin)
Dilantin is an anticonvulsant. As a side effect, when administered too fast, it can induce

N-Acetylcysteine (Mucomyst)
Mucomyst is given in cases of acetaminophen toxicity (e.g. Tylenol).

Tissue plasminogen activator is a thrombolytic agent, used to lyse blood clots in patients with
myocardial infarction (a.k.a. heart attacks), non-hemorrhagic CVA?s (a.k.a. strokes) and PE?s (a.k.a.

pulmonary emboli). Thrombolytics can cause hemorrhage and should be used with care.

Streptokinase is a thrombolytic (note: discovered here at NYU) made by Streptococcus bacteria
which dissolves clots, similar to tPA (although through a different mechanism)
Diltiazem is a calcium channel blocker used to slow the heart down in patients with certain
types of tachycardias such as atrial fibrillation.

Metoprolol is a beta-blocker which is used to slow down the heart and lower blood-pressure.

These drugs are not typically used in asthmatics, as they can induce bronchoconstriction.

Atenolol is a beta-blocker similar to metoprolol.

Adenosine (the A of ATP fame) is used as an antidysrhythmic to break certain cardiac
dysrhythmias; it is often used in patients with supraventricular tachycardia. The half life of the drug
is only a few seconds, and can often induce non-pathologic asystole (flat line on an EKG) for a few

Digoxin (a derivative of the Foxglove plant) is a cardiac drug used to slow conduction through
the heart, especially in cases of atrial-fibrillation. As a side effect it can produce various
dysrhythmias including ventricular fibrillation and aystole.

Metronidazole (Flagyl)
Flagyl is an antibiotic used against anaerobic bacteria and certain parasites. As a side effect
patients can become violently ill to their stomachs from consuming alcohol with Flagyl (similar to
Vancomycin is the ?last ditch? antibiotic, used for highly resistant bacteria. It is fairly toxic to the
patient, and often is a hobson?s choice to administer to a septic, shocky patient.

Trimethoprim/sulfamethoxazole (Bactrim)
Bactrim is a ?sulfa? class antibiotic and is often used in urinary tract infections.

A sedative often used in conjuction with other sedatives (such as midazolam or diazepam).

Pepcid is a systemic antacid (H2 blocker) which takes 30-45 minutes to take effect, but lasts for
several hours. Similar to ranitidine (Zantac) and cimetidine (Tagamet).

NS stands for Normal Saline, which is 0.9% Sodium Chloride, and is the usual fluid given to a
patient who needs fluid due to dehydration. It is approximately isotonic.

LR stands for Lactated Ringers, which is Normal Saline with other electrolytes. Due to the
presence of the other electrolytes, there is a limit to how much can be administered within a
specific period of time.

D5, D10, D25 and D50
The D stands for Dextrose, which is a stable form of glucose. This solution is given IV to give
the patient glucose. This is never given IM, as high concentrations of glucose cause tissue death
outside the vasculature.

Other useful terms
Once per Day
Twice per day
Three times per day
Four times per day
At the hour of sleep
Nothing by mouth


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